Viral And Sub-acute Menigitis

Question 1

Headache is almost invariably present in acute viral meningitis. What is the characteristics?

Answer 1

Frontal or retrorbital

Question 2

Nuchal rigidity in acute viral meningitis is pronounced. True or false?

Answer 2

False. Nuchal rigidity is only seen on maximal neck flexion

Question 3

Mild lethargy and drowsiness are common for acute viral meningitis. True or false?

Answer 3

True

Question 4

Sezure and focal neurologic findings are typical of acute viral meningits. True or false?

Answer 4

False

Question 5

CSF picture of acute viral meningitis?

Answer 5

Opening pressure- normal to slightly increased

Glucose- normal

Protein - normal or slightly elevated

Pleocytosis- present 25 - 500 with lymphocytic predominance

Question 6

Common viruses causing viral meningitis?

Answer 6

Entero virus ( cocksakie, echo, human entero 68-71)

Varicella - zoster
HSV 2 - associated with genital herpes
EBV
Arthropod borne
HIV

Question 7

The single most important method of diagnosis for CNS viral infections is?

Answer 7

PCR

Question 8

True or false

Neuro imaging studies are necessary for all cases of acute viral meningitis?

Answer 8

False - only those presenting with focal signs or altered LOC

Question 9

The most common cause of viral meningitis is?

Answer 9

Entero viruses causing upto 85% of cases

Question 10

In adults majority of HSV meningitis are caused by

HSV 1?
HSV 2?

Answer 10

HSV 2 - for viral meningitis

HSV 1 - for HSV encephalitsi comprising 90% of cases

Question 11

Cranial nerve palsies in HIV meningitis is common. What CN are usually involved?

Answer 11

CN V, VII, VIII

Question 12

A patient with viral meningitis has an elevated amylase, and lipase. This is most likely due to?

Answer 12

Mumps meningitis

Question 13

A patient who had exposure to mice or lab rats most probably has what etiology of viral meningitis?

Answer 13

LCMV

Lymphocytic chorio-meningitis virus

Question 14

What is the primary treatment for almost all cases of viral meningitis?

Answer 14

Symptomatic treatment

Unless seriosly ill
And with focal findings

Question 15

What is the treatment modality for complicated acute viral meningitis?

Answer 15

IV acyclovir 15-30 mg/kg 3 divided doses

Followed by oral acyclovir, famciclovir, valactclovir

Total duration is 7-14 days

Question 16

Common causes of sub-acute meningitis?

Answer 16

M tuberculosis
T Pallidum
H capsulatum
C immitis
C neoformans

Question 17

Most common pathogen causing fungal meningitis

Answer 17

C. Neoformans

Question 18

In Syphilis these cranial nerves are invaded

Answer 18

CN VII, VIII

Question 19

Classic CSF findings of tuberculous meningits?

Answer 19

Opening pressure - elevated

Protein - increased 1-5 g/L

Glucose - decreased

Cell count - lymphocyte 10 - 500

Question 20

The Gold standard for Tuberculous meningitis?

Answer 20

Culture

Question 21

What test establishses the diagnosis of cyptococcal meningits?

Answer 21

Cryptococcal polysaccharide antigen test

Question 22

Most common complication of fungal meningitis?

Answer 22

Hydrocephalus

Question 23

Treatment modality for syphylis meningitis?

Answer 23

Pen G 3-4 mil units q 4h x 10-14 datys